Job Details

ID #52678356
Estado Massachusetts
Ciudad Worcester / central MA
Full-time
Salario USD TBD TBD
Fuente Fallon Health
Showed 2024-10-10
Fecha 2024-10-11
Fecha tope 2024-12-09
Categoría Etcétera
Crear un currículum vítae
Aplica ya

Senior Care Enrollee Services Rep - Hybrid Remote - $22.50/hr

Massachusetts, Worcester / central MA, 01601 Worcester / central MA USA
Aplica ya

OverviewDo you enjoy helping the elderly and their families? Fallon Health is hiring an Enrolle Service Representative to work Hybrid-Remote, Mostly from Home but coming into the Worcester office 1 day/week (Wednesdays) helping people telephonically enroll into our very popular NaviCare program. We provide training and equipment. Schedule is M - F 8:00 am to 5:00 pm.About Fallon Health:Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high-quality coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter, and LinkedIn.About NaviCare :Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.Brief Summary of Purpose:The Enrollee Service Representative is responsible:

To execute the following tasks in accordance with the Senior Care Option (SCO) contract requirements, CMS regulations, NCQA standards, departmental policies and procedures, and other applicable regulatory requirements:

processing of enrollment applications

handling of all enrollee inquires, including but not limited to Medicare and Medicaid benefit handling prospect inquires

To serve as a liaison between enrollees and FCHP with their concerns regarding their Medicare/Medicaid benefits, denied claims, referrals, and membership.

ResponsibilitiesJob Responsibilities:

Provides coverage for the NaviCare enrollment ACD line and handles Enrollees inquiries in a timely manner

Serves as a subject matter expert in the NaviCare product and benefits.

Processes enrollment applications in accordance with regulatory requirements and departmental policies. Strict adherence to department turn-around time standards. Ensures the enrollment database is maintained on a daily basis.

Validates enrollment with the confirmation of receipt of the enrollment (834) transaction.

Handles enrollees’ inquires in a timely manner and Utilizes CMS approved scripts as appropriate

Assists enrollees with their inquires related to Medicare and Medicaid benefits

Supports the outreach and enrollment teams as a resource

Handles enrollee’s billing issues and presents them to NaviCare Clinical Directors or other internal and external physician reviewers as appropriate.

Assist contracted providers with pended claims issues

Ability to protect high degree of confidential/privileged patient and proprietary business information

Ability to function effectively in a fast-paced environment and effectively deal with competing priorities

Ability to synthesize all applicable regulatory requirements for NCQA, CMS and SCO contract.

QualificationsEducation:Bachelor’s degree or equivalent combination of education and experienceLicense/Certifications:

Annually, required to pass a product certification exam

Annually, required to take the AHIP certification

Experience:

1 – 3 years of previous professional experience in a related position, preferable healthcare.

Ability to communicate and present information to various levels of personnel.

Working knowledge of computer programs and software.

Excellent interpersonal skills, ability to negotiate with customers and remain diplomatic.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.Location US-MA-WorcesterPosted Date 4 hours ago (10/10/2024 4:17 PM)Job ID 7738# Positions 1Category Other

Aplica ya Suscribir Reportar trabajo